Skip to main content
Environmental Health Perspectives logoLink to Environmental Health Perspectives
. 2001 Aug;109(Suppl 4):591–598. doi: 10.1289/ehp.01109s4591

Effects of ozone and endotoxin coexposure on rat airway epithelium: potentiation of toxicant-induced alterations.

J G Wagner 1, J A Hotchkiss 1, J R Harkema 1
PMCID: PMC1240587  PMID: 11544169

Abstract

Tropospheric ozone is the major oxidizing component in photochemical smog and is one of the most pervasive problems to human health of the criteria air pollutants for which the National Ambient Air Quality Standards have been designated by the Clean Air Act. Although many adverse health effects of ozone exposure have been documented in both humans and laboratory animals, controversy surrounds the establishment and implementation of ozone standards set forth by the U.S. Environmental Protection Agency. Because people are commonly exposed to more than one air pollutant at a time, studies that examine coexposures to airborne materials may be more relevant for assessing their risks to human health. Airborne biogenic substances such as pollens, spores, and bacterial products are ubiquitous in the environment, and when inhaled can cause adverse respiratory symptoms. One such biogenic agent, bacterial endotoxin, is a potent stimulus of airway inflammation and is a ubiquitous airborne contaminant commonly found in domestic, agricultural, and industrial settings. Little is known about the interaction of exposures to biogenic substances and criteria air pollutants such as ozone. In the last few years we have performed a series of studies in rodents that examined the biologic responses of the respiratory epithelium after airway exposures to both endotoxin and ozone. When exposed to ozone (0.5 ppm 8 hr/day for 3 days), Fischer rats develop lesions in the nasal transitional epithelium, whereas intranasal instillation of endotoxin (20 microg) elicits epithelial lesions in the respiratory epithelium of the nose and conducting airways. Our studies were designed to examine how exposure to one toxicant may affect the airway epithelial lesions induced by the other toxicant. We investigated the potential role of acute inflammation in the enhancement of airway epithelial lesions after exposure of these two toxicants in neutrophil-sufficient and neutrophil-deficient rodents. A summary of these results indicates that epithelial and inflammatory responses to coexposure of these two pollutants are greater than those elicited by either agent alone. Interestingly, each toxicant enhances the epithelial alterations induced by the other. Furthermore, the synergistic effects elicited by coexposure to ozone and endotoxin are mediated partly by neutrophils. These studies provided some new insights into how inhaled co-pollutants interact to initiate and promote alterations of airway epithelium. Further studies with these and other air pollutants will help define their true risk to human health.

Full Text

The Full Text of this article is available as a PDF (90.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Basbaum C., Lemjabbar H., Longphre M., Li D., Gensch E., McNamara N. Control of mucin transcription by diverse injury-induced signaling pathways. Am J Respir Crit Care Med. 1999 Nov;160(5 Pt 2):S44–S48. doi: 10.1164/ajrccm.160.supplement_1.12. [DOI] [PubMed] [Google Scholar]
  2. Borchers M. T., Carty M. P., Leikauf G. D. Regulation of human airway mucins by acrolein and inflammatory mediators. Am J Physiol. 1999 Apr;276(4 Pt 1):L549–L555. doi: 10.1152/ajplung.1999.276.4.L549. [DOI] [PubMed] [Google Scholar]
  3. Breslin K. EPA: airing on the side of caution or pulling standards out of thin Air? Environ Health Perspect. 2000 Apr;108(4):A176–A177. doi: 10.1289/ehp.108-a176. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Breuer R., Christensen T. G., Lucey E. C., Bolbochan G., Stone P. J., Snider G. L. Elastase causes secretory discharge in bronchi of hamsters with elastase-induced secretory cell metaplasia. Exp Lung Res. 1993 Mar-Apr;19(2):273–282. doi: 10.3109/01902149309031724. [DOI] [PubMed] [Google Scholar]
  5. Breuer R., Christensen T. G., Lucey E. C., Stone P. J., Snider G. L. Quantitative study of secretory cell metaplasia induced by human neutrophil elastase in the large bronchi of hamsters. J Lab Clin Med. 1985 May;105(5):635–640. [PubMed] [Google Scholar]
  6. Calderon-Garcidueñas L., Osorno-Velazquez A., Bravo-Alvarez H., Delgado-Chavez R., Barrios-Marquez R. Histopathologic changes of the nasal mucosa in southwest Metropolitan Mexico City inhabitants. Am J Pathol. 1992 Jan;140(1):225–232. [PMC free article] [PubMed] [Google Scholar]
  7. Calderon-Garcidueñas L., Rodriguez-Alcaraz A., Garcia R., Sanchez G., Barragan G., Camacho R., Ramirez L. Human nasal mucosal changes after exposure to urban pollution. Environ Health Perspect. 1994 Dec;102(12):1074–1080. doi: 10.1289/ehp.102-1567497. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Calderón-Garcidueñas L., Rodriguez-Alcaraz A., García R., Ramírez L., Barragan G. Nasal inflammatory responses in children exposed to a polluted urban atmosphere. J Toxicol Environ Health. 1995 Aug;45(4):427–437. doi: 10.1080/15287399509532006. [DOI] [PubMed] [Google Scholar]
  9. Cho H. Y., Hotchkiss J. A., Bennett C. B., Harkema J. R. Neutrophil-dependent and neutrophil-independent alterations in the nasal epithelium of ozone-exposed rats. Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):629–636. doi: 10.1164/ajrccm.162.2.9811078. [DOI] [PubMed] [Google Scholar]
  10. Cho H. Y., Hotchkiss J. A., Harkema J. R. Inflammatory and epithelial responses during the development of ozone-induced mucous cell metaplasia in the nasal epithelium of rats. Toxicol Sci. 1999 Sep;51(1):135–145. doi: 10.1093/toxsci/51.1.135. [DOI] [PubMed] [Google Scholar]
  11. Chomczynski P., Mackey K. Substitution of chloroform by bromo-chloropropane in the single-step method of RNA isolation. Anal Biochem. 1995 Feb 10;225(1):163–164. doi: 10.1006/abio.1995.1126. [DOI] [PubMed] [Google Scholar]
  12. Chomczynski P., Sacchi N. Single-step method of RNA isolation by acid guanidinium thiocyanate-phenol-chloroform extraction. Anal Biochem. 1987 Apr;162(1):156–159. doi: 10.1006/abio.1987.9999. [DOI] [PubMed] [Google Scholar]
  13. Christensen T. G., Alonso P. A. Immunocytochemical evidence for extra-cellular initiation of elastase-induced bronchial secretory cell metaplasia in hamsters. Eur Respir J. 1996 Mar;9(3):535–541. doi: 10.1183/09031936.96.09030535. [DOI] [PubMed] [Google Scholar]
  14. Cody R. P., Weisel C. P., Birnbaum G., Lioy P. J. The effect of ozone associated with summertime photochemical smog on the frequency of asthma visits to hospital emergency departments. Environ Res. 1992 Aug;58(2):184–194. doi: 10.1016/s0013-9351(05)80214-2. [DOI] [PubMed] [Google Scholar]
  15. Davreux C. J., Soric I., Nathens A. B., Watson R. W., McGilvray I. D., Suntres Z. E., Shek P. N., Rotstein O. D. N-acetyl cysteine attenuates acute lung injury in the rat. Shock. 1997 Dec;8(6):432–438. [PubMed] [Google Scholar]
  16. Eldridge M. W., Peden D. B. Allergen provocation augments endotoxin-induced nasal inflammation in subjects with atopic asthma. J Allergy Clin Immunol. 2000 Mar;105(3):475–481. doi: 10.1067/mai.2000.104552. [DOI] [PubMed] [Google Scholar]
  17. Fanucchi M. V., Harkema J. R., Plopper C. G., Hotchkiss J. A. In vitro culture of microdissected rat nasal airway tissues. Am J Respir Cell Mol Biol. 1999 Jun;20(6):1274–1285. doi: 10.1165/ajrcmb.20.6.3451. [DOI] [PubMed] [Google Scholar]
  18. Fanucchi M. V., Hotchkiss J. A., Harkema J. R. Endotoxin potentiates ozone-induced mucous cell metaplasia in rat nasal epithelium. Toxicol Appl Pharmacol. 1998 Sep;152(1):1–9. doi: 10.1006/taap.1998.8484. [DOI] [PubMed] [Google Scholar]
  19. Farman C. A., Watkins K., van Hoozen B., Last J. A., Witschi H., Pinkerton K. E. Centriacinar remodeling and sustained procollagen gene expression after exposure to ozone and nitrogen dioxide. Am J Respir Cell Mol Biol. 1999 Feb;20(2):303–311. doi: 10.1165/ajrcmb.20.2.3269. [DOI] [PubMed] [Google Scholar]
  20. Fauroux B., Sampil M., Quénel P., Lemoullec Y. Ozone: a trigger for hospital pediatric asthma emergency room visits. Pediatr Pulmonol. 2000 Jul;30(1):41–46. doi: 10.1002/1099-0496(200007)30:1<41::aid-ppul7>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  21. Fisher D. A., Lakshmanan J. Metabolism and effects of epidermal growth factor and related growth factors in mammals. Endocr Rev. 1990 Aug;11(3):418–442. doi: 10.1210/edrv-11-3-418. [DOI] [PubMed] [Google Scholar]
  22. Flaherty D. K., Deck F. H., Cooper J., Bishop K., Winzenburger P. A., Smith L. R., Bynum L., Witmer W. B. Bacterial endotoxin isolated from a water spray air humidification system as a putative agent of occupation-related lung disease. Infect Immun. 1984 Jan;43(1):206–212. doi: 10.1128/iai.43.1.206-212.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Frischer T. M., Kuehr J., Pullwitt A., Meinert R., Forster J., Studnicka M., Koren H. Ambient ozone causes upper airways inflammation in children. Am Rev Respir Dis. 1993 Oct;148(4 Pt 1):961–964. doi: 10.1164/ajrccm/148.4_Pt_1.961. [DOI] [PubMed] [Google Scholar]
  24. Gilliland G., Perrin S., Blanchard K., Bunn H. F. Analysis of cytokine mRNA and DNA: detection and quantitation by competitive polymerase chain reaction. Proc Natl Acad Sci U S A. 1990 Apr;87(7):2725–2729. doi: 10.1073/pnas.87.7.2725. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Gold D. R., Damokosh A. I., Pope C. A., 3rd, Dockery D. W., McDonnell W. F., Serrano P., Retama A., Castillejos M. Particulate and ozone pollutant effects on the respiratory function of children in southwest Mexico City. Epidemiology. 1999 Jan;10(1):8–16. [PubMed] [Google Scholar]
  26. Gordon T., Harkema J. R. Effect of inhaled endotoxin on intraepithelial mucosubstances in F344 rat nasal and tracheobronchial airways. Am J Respir Cell Mol Biol. 1994 Feb;10(2):177–183. doi: 10.1165/ajrcmb.10.2.8110474. [DOI] [PubMed] [Google Scholar]
  27. Graham D. E., Koren H. S. Biomarkers of inflammation in ozone-exposed humans. Comparison of the nasal and bronchoalveolar lavage. Am Rev Respir Dis. 1990 Jul;142(1):152–156. doi: 10.1164/ajrccm/142.1.152. [DOI] [PubMed] [Google Scholar]
  28. Hanisch F. G., Müller S. MUC1: the polymorphic appearance of a human mucin. Glycobiology. 2000 May;10(5):439–449. doi: 10.1093/glycob/10.5.439. [DOI] [PubMed] [Google Scholar]
  29. Harkema J. R., Hotchkiss J. A., Henderson R. F. Effects of 0.12 and 0.80 ppm ozone on rat nasal and nasopharyngeal epithelial mucosubstances: quantitative histochemistry. Toxicol Pathol. 1989;17(3):525–535. doi: 10.1177/019262338901700307. [DOI] [PubMed] [Google Scholar]
  30. Harkema J. R., Hotchkiss J. A. In vivo effects of endotoxin on intraepithelial mucosubstances in rat pulmonary airways. Quantitative histochemistry. Am J Pathol. 1992 Aug;141(2):307–317. [PMC free article] [PubMed] [Google Scholar]
  31. Harkema J. R., Hotchkiss J. A. In vivo effects of endotoxin on nasal epithelial mucosubstances: quantitative histochemistry. Exp Lung Res. 1991 Jul-Aug;17(4):743–761. doi: 10.3109/01902149109062876. [DOI] [PubMed] [Google Scholar]
  32. Harkema J. R., Hotchkiss J. A. Ozone- and endotoxin-induced mucous cell metaplasias in rat airway epithelium: novel animal models to study toxicant-induced epithelial transformation in airways. Toxicol Lett. 1993 May;68(1-2):251–263. doi: 10.1016/0378-4274(93)90136-l. [DOI] [PubMed] [Google Scholar]
  33. Harkema J. R., Plopper C. G., Hyde D. M., St George J. A., Wilson D. W., Dungworth D. L. Response of the macaque nasal epithelium to ambient levels of ozone. A morphologic and morphometric study of the transitional and respiratory epithelium. Am J Pathol. 1987 Jul;128(1):29–44. [PMC free article] [PubMed] [Google Scholar]
  34. Hiltermann T. J., Peters E. A., Alberts B., Kwikkers K., Borggreven P. A., Hiemstra P. S., Dijkman J. H., van Bree L. A., Stolk J. Ozone-induced airway hyperresponsiveness in patients with asthma: role of neutrophil-derived serine proteinases. Free Radic Biol Med. 1998 Apr;24(6):952–958. doi: 10.1016/s0891-5849(97)00381-x. [DOI] [PubMed] [Google Scholar]
  35. Hiltermann T. J., de Bruijne C. R., Stolk J., Zwinderman A. H., Spieksma F. T., Roemer W., Steerenberg P. A., Fischer P. H., van Bree L., Hiemstra P. S. Effects of photochemical air pollution and allergen exposure on upper respiratory tract inflammation in asthmatics. Am J Respir Crit Care Med. 1997 Dec;156(6):1765–1772. doi: 10.1164/ajrccm.156.6.9704127. [DOI] [PubMed] [Google Scholar]
  36. Holgate S. T. Epithelial damage and response. Clin Exp Allergy. 2000 Jun;30 (Suppl 1):37–41. doi: 10.1046/j.1365-2222.2000.00095.x. [DOI] [PubMed] [Google Scholar]
  37. Hotchkiss J. A., Harkema J. R., Henderson R. F. Effect of cumulative ozone exposure on ozone-induced nasal epithelial hyperplasia and secretory metaplasia in rats. Exp Lung Res. 1991 May-Jun;17(3):589–600. doi: 10.3109/01902149109062867. [DOI] [PubMed] [Google Scholar]
  38. Hotchkiss J. A., Harkema J. R., Johnson N. F. Kinetics of nasal epithelial cell loss and proliferation in F344 rats following a single exposure to 0.5 ppm ozone. Toxicol Appl Pharmacol. 1997 Mar;143(1):75–82. doi: 10.1006/taap.1996.8055. [DOI] [PubMed] [Google Scholar]
  39. Hotchkiss J. A., Hilaski R., Cho H., Regan K., Spencer P., Slack K., Harkema J. R. Fluticasone propionate attenuates ozone-induced rhinitis and mucous cell metaplasia in rat nasal airway epithelium. Am J Respir Cell Mol Biol. 1998 Jan;18(1):91–99. doi: 10.1165/ajrcmb.18.1.2897. [DOI] [PubMed] [Google Scholar]
  40. Jamil S., Breuer R., Christensen T. G. Abnormal mucous cell phenotype induced by neutrophil elastase in hamster bronchi. Exp Lung Res. 1997 Jul-Aug;23(4):285–295. doi: 10.3109/01902149709039227. [DOI] [PubMed] [Google Scholar]
  41. Järvholm B., Bake B., Lavenius B., Thiringer G., Vokmann R. Respiratory symptoms and lung function in oil mist-exposed workers. J Occup Med. 1982 Jun;24(6):473–479. [PubMed] [Google Scholar]
  42. Järvholm B. Cutting oil mist and bronchitis. Eur J Respir Dis Suppl. 1982;118:79–83. [PubMed] [Google Scholar]
  43. Kawabata A., Morimoto N., Nishikawa H., Kuroda R., Oda Y., Kakehi K. Activation of protease-activated receptor-2 (PAR-2) triggers mucin secretion in the rat sublingual gland. Biochem Biophys Res Commun. 2000 Apr 2;270(1):298–302. doi: 10.1006/bbrc.2000.2404. [DOI] [PubMed] [Google Scholar]
  44. Kawabata K., Hagio T., Matsumoto S., Nakao S., Orita S., Aze Y., Ohno H. Delayed neutrophil elastase inhibition prevents subsequent progression of acute lung injury induced by endotoxin inhalation in hamsters. Am J Respir Crit Care Med. 2000 Jun;161(6):2013–2018. doi: 10.1164/ajrccm.161.6.9904047. [DOI] [PubMed] [Google Scholar]
  45. Last J. A., Pinkerton K. E. Chronic exposure of rats to ozone and sulfuric acid aerosol: biochemical and structural responses. Toxicology. 1997 Jan 15;116(1-3):133–146. doi: 10.1016/s0300-483x(96)03535-4. [DOI] [PubMed] [Google Scholar]
  46. Linn W. S., Szlachcic Y., Gong H., Jr, Kinney P. L., Berhane K. T. Air pollution and daily hospital admissions in metropolitan Los Angeles. Environ Health Perspect. 2000 May;108(5):427–434. doi: 10.1289/ehp.00108427. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Lippmann M., Schlesinger R. B. Toxicological bases for the setting of health-related air pollution standards. Annu Rev Public Health. 2000;21:309–333. doi: 10.1146/annurev.publhealth.21.1.309. [DOI] [PubMed] [Google Scholar]
  48. Lou Y. P., Takeyama K., Grattan K. M., Lausier J. A., Ueki I. F., Agustí C., Nadel J. A. Platelet-activating factor induces goblet cell hyperplasia and mucin gene expression in airways. Am J Respir Crit Care Med. 1998 Jun;157(6 Pt 1):1927–1934. doi: 10.1164/ajrccm.157.6.9709113. [DOI] [PubMed] [Google Scholar]
  49. Michel O., Nagy A. M., Schroeven M., Duchateau J., Nève J., Fondu P., Sergysels R. Dose-response relationship to inhaled endotoxin in normal subjects. Am J Respir Crit Care Med. 1997 Oct;156(4 Pt 1):1157–1164. doi: 10.1164/ajrccm.156.4.97-02002. [DOI] [PubMed] [Google Scholar]
  50. Nogami H., Aizawa H., Matsumoto K., Nakano H., Koto H., Miyazaki H., Hirose T., Nishima S., Hara N. Neutrophil elastase inhibitor, ONO-5046 suppresses ozone-induced airway mucus hypersecretion in guinea pigs. Eur J Pharmacol. 2000 Feb 25;390(1-2):197–202. doi: 10.1016/s0014-2999(99)00921-8. [DOI] [PubMed] [Google Scholar]
  51. Oxhøj H., Andreasen H., Henius U. M. Respiratory symptoms and ventilatory lung function in machine shop workers exposed to coolant-lubricants. Eur J Respir Dis Suppl. 1982;118:85–89. [PubMed] [Google Scholar]
  52. PERNIS B., VIGLIANI E. C., CAVAGNA C., FINULLI M. The role of bacterial endotoxins in occupational diseases caused by inhaling vegetable dusts. Br J Ind Med. 1961 Apr;18:120–129. doi: 10.1136/oem.18.2.120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. PETERSON R. D., WICKLUNDS P. E., GOOD R. A. ENDOTOXIN ACTIVITY OF A HOUSE DUST EXTRACT. J Allergy. 1964 Mar-Apr;35:134–142. doi: 10.1016/0021-8707(64)90027-9. [DOI] [PubMed] [Google Scholar]
  54. Peden D. B., Tucker K., Murphy P., Newlin-Clapp L., Boehlecke B., Hazucha M., Bromberg P., Reed W. Eosinophil influx to the nasal airway after local, low-level LPS challenge in humans. J Allergy Clin Immunol. 1999 Aug;104(2 Pt 1):388–394. doi: 10.1016/s0091-6749(99)70383-0. [DOI] [PubMed] [Google Scholar]
  55. Rylander R., Haglind P. Airborne endotoxins and humidifier disease. Clin Allergy. 1984 Jan;14(1):109–112. doi: 10.1111/j.1365-2222.1984.tb02197.x. [DOI] [PubMed] [Google Scholar]
  56. Rylander R., Nordstrand A. Pulmonary cell reactions after exposure to cotton dust extract. Br J Ind Med. 1974 Jul;31(3):220–223. doi: 10.1136/oem.31.3.220. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Sheppard L., Levy D., Norris G., Larson T. V., Koenig J. Q. Effects of ambient air pollution on nonelderly asthma hospital admissions in Seattle, Washington, 1987-1994. Epidemiology. 1999 Jan;10(1):23–30. [PubMed] [Google Scholar]
  58. Simpson J. C., Niven R. M., Pickering C. A., Oldham L. A., Fletcher A. M., Francis H. C. Comparative personal exposures to organic dusts and endotoxin. Ann Occup Hyg. 1999 Feb;43(2):107–115. [PubMed] [Google Scholar]
  59. Snipes M. B., Barnett A. L., Harkema J. R., Hotchkiss J. A., Rebar A. H., Reddick L. J. Specific biological effects of an anti-rat PMN antiserum intraperitoneally infected into f344/n rats. Vet Clin Pathol. 1995;24(1):11–17. doi: 10.1111/j.1939-165x.1995.tb00928.x. [DOI] [PubMed] [Google Scholar]
  60. Steiger D., Hotchkiss J., Bajaj L., Harkema J., Basbaum C. Concurrent increases in the storage and release of mucin-like molecules by rat airway epithelial cells in response to bacterial endotoxin. Am J Respir Cell Mol Biol. 1995 Mar;12(3):307–314. doi: 10.1165/ajrcmb.12.3.7873197. [DOI] [PubMed] [Google Scholar]
  61. Stieb D. M., Burnett R. T., Beveridge R. C., Brook J. R. Association between ozone and asthma emergency department visits in Saint John, New Brunswick, Canada. Environ Health Perspect. 1996 Dec;104(12):1354–1360. doi: 10.1289/ehp.961041354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Takeyama K., Agustí C., Ueki I., Lausier J., Cardell L. O., Nadel J. A. Neutrophil-dependent goblet cell degranulation: role of membrane-bound elastase and adhesion molecules. Am J Physiol. 1998 Aug;275(2 Pt 1):L294–L302. doi: 10.1152/ajplung.1998.275.2.L294. [DOI] [PubMed] [Google Scholar]
  63. Takeyama K., Dabbagh K., Lee H. M., Agustí C., Lausier J. A., Ueki I. F., Grattan K. M., Nadel J. A. Epidermal growth factor system regulates mucin production in airways. Proc Natl Acad Sci U S A. 1999 Mar 16;96(6):3081–3086. doi: 10.1073/pnas.96.6.3081. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Thurston G. D., Ito K., Kinney P. L., Lippmann M. A multi-year study of air pollution and respiratory hospital admissions in three New York State metropolitan areas: results for 1988 and 1989 summers. J Expo Anal Environ Epidemiol. 1992 Oct-Dec;2(4):429–450. [PubMed] [Google Scholar]
  65. Vagaggini B., Carnevali S., Macchioni P., Taccola M., Fornai E., Bacci E., Bartoli M. L., Cianchetti S., Dente F. L., Di Franco A. Airway inflammatory response to ozone in subjects with different asthma severity. Eur Respir J. 1999 Feb;13(2):274–280. doi: 10.1034/j.1399-3003.1999.13b09.x. [DOI] [PubMed] [Google Scholar]
  66. Voynow J. A., Young L. R., Wang Y., Horger T., Rose M. C., Fischer B. M. Neutrophil elastase increases MUC5AC mRNA and protein expression in respiratory epithelial cells. Am J Physiol. 1999 May;276(5 Pt 1):L835–L843. doi: 10.1152/ajplung.1999.276.5.L835. [DOI] [PubMed] [Google Scholar]
  67. Wesselius L. J., Nelson M. E., Bailey K., O'Brien-Ladner A. R. Rapid lung cytokine accumulation and neutrophil recruitment after lipopolysaccharide inhalation by cigarette smokers and nonsmokers. J Lab Clin Med. 1997 Jan;129(1):106–114. doi: 10.1016/s0022-2143(97)90167-0. [DOI] [PubMed] [Google Scholar]
  68. Wills-Karp M. Trophic slime, allergic slime. Am J Respir Cell Mol Biol. 2000 Jun;22(6):637–639. doi: 10.1165/ajrcmb.22.6.f190. [DOI] [PubMed] [Google Scholar]
  69. Wong T. W., Lau T. S., Yu T. S., Neller A., Wong S. L., Tam W., Pang S. W. Air pollution and hospital admissions for respiratory and cardiovascular diseases in Hong Kong. Occup Environ Med. 1999 Oct;56(10):679–683. doi: 10.1136/oem.56.10.679. [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. el-Fawal H. A., McGovern T., Schlesinger R. B. Nonspecific bronchial responsiveness assessed in vitro following acute inhalation exposure to ozone and ozone/sulfuric acid mixtures. Exp Lung Res. 1995 Jan-Feb;21(1):129–139. doi: 10.3109/01902149509031749. [DOI] [PubMed] [Google Scholar]

Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Sciences

RESOURCES